Provider First Line Business Practice Location Address:
414 SOUTH PAYNE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ULM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-233-6120
Provider Business Practice Location Address Fax Number:
507-233-6181
Provider Enumeration Date:
12/22/2006